Basic Information
| Provider Information | |||||||||
| NPI: | 1588807739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGO-REYES | ||||||||
| FirstName: | LINH | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | MPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NGO | ||||||||
| OtherFirstName: | LINH | ||||||||
| OtherMiddleName: | N. | ||||||||
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| OtherCredential: | MPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 24630 WASHINGTON AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925626177 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10020 INDIANA AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925035477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516372320 | ||||||||
| FaxNumber: | 9516372321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2009 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT35438 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.